Doctors take first key step in saving our health service
Monday's decision by doctors to go ahead with a series of strikes beginning next Tuesday can be taken as confirmation that the multiple crises in the health service are converging towards a perfect storm.
The doctors' dispute has to do with a new contract which the Department of Health is intent on imposing. The effect would be to redefine the normal working week to include Saturdays and late evenings.
According to the British Medical Association (BMA), it would also lead to a drop in pay. The contract has already been rejected by the devolved administrations in Scotland and Wales. What happens here and in England will be determined by the outcome of the industrial action which now seems inevitable.
The dispute is one of a number which has been simmering within the health service for a considerable time. The settled reluctance of doctors and nurses to withdraw their labour has prevented any of the difficulties boiling over.
But hospital staff have come to believe that their dedication to patients has been taken advantage of by the Government and health service management. In taking a stand now, the doctors are standing up for the health service itself.
The health service deals with a million people every 36 hours. At the last count, it employed 150,273 doctors, 377,191 nurses, 155,960 scientific, therapeutic and technical staff and 37,078 administrators. It is the fifth-biggest employer in the world.
There are bound to be problems. But the major problems currently assailing the service have not emerged from within, but have been contrived by an ideologically-driven Government that boasts of its devotion to the health service, but, in practice, seems set on its destruction.
A different aspect of the same induced malaise was evident last weekend in reports of nurses from the Royal Victoria Hospital and City Hospital in Belfast having been hired by an agency to work weekends at short-staffed English hospitals at rates substantially above the NHS norm (in fact, the quoted fees ignored deductions by the agency for its own costs and to fund its profits. Some media estimates of the money being made by the nurses have been seriously inflated).
It is a measure of the irrational way the health service is being run that, as agencies send nurses from Belfast to fill gaps in rotas elsewhere, more than £200m has been spent by northern trusts in the last five years hiring agency doctors and nurses to fill gaps left by understaffing here. The biggest spend - £48m - has been by the Belfast Trust, which covers the Royal and the City.
Stormont's Public Accounts Committee last August accused the agencies involved of "creaming off substantial profits at the taxpayers' expense".
The north is the only part of the UK where nurses have been offered no pay rise for 2015-16. Royal College of Nursing (RCN) Northern Ireland director Janice Smith calculates that an experienced staff nurse in Northern Ireland is now paid £279 a year less than in England and £561 less than in Scotland.
In real terms, nurses here are 10% worse off than in 2008. The RCN has resolved to ballot them on industrial action short of a strike. The nurses, too, have had enough.
The RCN reported last July that there were 361 nursing vacancies in private nursing homes in the north. More than 12,000 people - almost all of them elderly, many with challenging needs - are dependent on the sector.
But chronic underfunding ensures that many of their needs cannot be met. A number of homes have been closed or threatened with closure. Those which remain are finding it difficult to recruit and retain staff.
Cuts in social care budgets mean less than adequate care in the community. As a result, more and more people dependent on care end up in hospitals, exacerbating the other problems.
The convergence of the crises continues.
In spite of all these difficulties and drawbacks the health service remains by far the most popular institution in the land. If public opinion were decisive, the cats' cradle of contradictions could rapidly be resolved. But that's not on the Tory agenda. Chancellor George Osborne is intent on squeezing another £10bn from health by 2020.
Unless sufficient pressure can be mounted to force the Westminster Government into a radical rethink, the continuance of the health service as a universal service, delivering top-class care free at the point of use is far from secure.
The first step towards saving the service will come next Tuesday. All who cherish the health service should let the doctors know - loudly - that we are all on their side.